PTSD
Post-Traumatic Stress
Disorder
Events that occur during a war are
far
from the range of normal everyday experiences. These sights, sounds
and memories can cause veterans to have problems following their time in the war
zone.
It appears particularly unsettling for troops to go from a war zone back to 'The World' almost overnight. Vietnam GI's were typically transferred alone, separate from their units, and often found themselves in a combat zone one day and back in the U.S. a day or two later. That's a sharp contrast to World War Two when most soldiers shipped home with their units on troop transports, allowing the soldiers a couple weeks to process their war memories and 'decompress.'
Prior to the Vietnam War, there were
several names for PTSD: neurasthenia, shell shock, war neurosis, and combat
fatigue. Following the Vietnam War, the term "Post-traumatic Stress
Disorder" was coined.
One of the most promising therapies for
victims of PTSD is known as "EMDR - Eye Movement Desensitization and
Reprocessing." Psychologist Francine Shapiro of the Mental
Research Institute in Palo
Alto, California, discovered the technique by chance. She went on to
do an initial study with 22 victims of trauma, using a technique where the
patient follows an object which she moves back and forth with her hand,
mimicking the movement of a slow windshield wiper on an automobile. It
worked!
"Traumatic feelings and pictures
from earlier life experiences become locked in the nervous system in their
original disturbing form," she says. "Perhaps EMDR unlocks them
because the eye movements in EMDR are similar to eye movements that happen
during REM (rapid eye movement) sleep, which is when the brain processes
disturbing memories. In a waking state, EMDR may stimulate
reprocessing of traumatic memories and their associated thoughts and feelings by
opening up a network of traumatic memories to input from the conscious
mind...."
(See the September 1994 issue of AMERICAN HEALTH magazine for the
entire article)
PTSD
diagnostic criteria from the DSM-III
Post-traumatic Stress Disorder (309.89)
Essential feature. Characteristic symptoms following a
psychologically
distressing event that is outside the range of usual human experience. The
original stressor is usually experienced with intense fear, terror, and/or
helplessness.
The precipitating stressor must not be one which is usually well tolerated by
most other members of the cultural group (e.g., death of a loved one,
ordinary traffic accident). Post-traumatic Stress Disorder need not develop in
every victim. Traumas may be experienced alone, e.g., rape, severe physical
assault) or in groups (e.g., military combat, unusually serious automobile
accidents). The stressor may arise from natural, accidental, or purposeful
events.
Age-specific features.
The disorder in children may present
differently (see below).
Associated features. Depression and anxiety are common and may be
diagnosed as separate disorders. Compulsive behavior or changes of routine or
lifestyle may occur. Pseudo -"organic" symptoms, such as memory
problems, difficulty in concentrating, or emotional lability, may occur and may
be confused with Somatoform Disorders. "Survivor's guilt" may occur,
particularly if others were killed in the traumatic event. Impairment may be
mild or severe and may affect almost any aspect of life. Phobic avoidance of
real or symbolic reminders of the trauma may occur.
Differential diagnosis:
If criteria for Anxiety Disorders, Depressive
Disorders, or Organic Mental Disorders are fully met, these diagnoses should
also be made. "Adjustment Disorder" implies a less severe trauma, and
the patient does not meet all of the criteria listed below.
Diagnostic criteria for Post-Traumatic Stress Disorder:
A. The person has experienced an
event that is outside the range of usual human experience and that would be
markedly distressing to almost anyone.
B. The traumatic event is
persistently re-experienced in at least one of the following ways:
1. recurrent and intrusive,
distressing recollections of the event (in young children, repetitive play in
which themes or aspects of the trauma are expressed)
2. recurrent distressing dreams
of the event
3. sudden acting or feeling as
if the traumatic event were recurring (including "flashback" or
dissociative episodes, whether or not intoxicated)
4. intense psychological
distress at exposure to events that symbolize or resemble an aspect of the
traumatic event, including anniversaries
C. Persistent avoidance of stimuli
associated with the trauma or numbing of general responsiveness, as indicated by
at least three of the following:
1. efforts to avoid thoughts or
feeling associated with the trauma
2. efforts to avoid activities
or situations that arouse recollections of the trauma
3. inability to recall an
important aspect of the trauma (psychogenic amnesia)
4. markedly diminished interest
in significant activities (in young children, loss of recently acquired
developmental skills such as toilet training or language skills)
5. feeling of detachment or
estrangement from others
6. restricted range of affect
7. sense of foreshortened future
(e.g., the patient does not expect to live very long or to have a successful
career)
D. Persistent symptoms of
increased arousal (not present before the trauma), as indicated by at least two
of the following:
1. difficulty falling or staying
asleep
2. irritability or outbursts of
anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response
6. physiological activity upon
exposure to events that symbolize or resemble an aspect of the traumatic event
E. Duration of disturbance
(symptoms in "B," "C," and "D") of at least one
month.
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